績效型醫師費制度之建置與實際運用探討

Establishment and Application of Performance-Based Hospital Physician Fee System

雖然過去醫師薪資制度對臨床表現及績效所造成的結果分歧，但一般咸信金錢報酬能促進醫師績效。本文簡要回顧台灣過去醫師薪資系統的起源及發展，並提出一套績效型導向的醫師費制度，期能兼顧醫師薪資公平及醫院財務風險分擔，並實際應用此績效型醫師費制度於某區域級醫院中。執行新制後，個案醫院各科的醫師費大多降低，個案醫院整體營收與損益都有改善。建議未來可深入探討績效型醫師費制度對醫師成本管控能力提升及對醫師醫療行為改變之影響機制。

Although the findings in empirical studies about the impact of physician salary on clinical performance have been diverse, most believe in the assumption that monetary feedback can be used to enhance physicians’ performance. The study has briefly reviewed the origin and development of this salaried approach for physicians, and proposed a Performance-Based Hospital Physician Fee System in order to ensure the financial risk sharing for hospital management in addition to physician payment justice. This study has also demonstrated the application of Performance-Based Hospital Physician Fee System in a regional hospital in Taiwan. Most physicians in this regional hospital had salaried less after implementing Performance-Based Hospital Physician Fee System, and the overall hospital showed better performance according to its profit and loss. To better understand the relationship between Performance-Based Hospital Physician Fee System and patterns of physician behaviors, further studies are recommended to explore the impact mechanisms of the system on the medical behaviors and the cost control capability of physicians.